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ClosingtheCoverageGap
Insurance StatusinVirginia
VirginiaPopulation Insured: Medicare,65andover(13%) CurrentMedicaidEnrollment(FY2014) Allotherinsured Uninsured64andunder TOTALPopulation Uninsured Breakdown Uninsured(above) Inprivateexchange EligibleforCoverageGap(estimated) 1,030,000 470,700 400,000 1,073,853 1,147,800 5,008,752 1,030,000 8,260,405
Closing the CoverageGap

8,260,405

(Remaininguninsuredindividualsmaynotbeeligibleforcoverageduetoa numberofreasonssuchasimmigrationstatus)

WhereareVirginiasUninsured?

WhoareVirginiasUninsured?
Thevastmajority(71.3%) arepartofworkingfamilies Themajority(80%)are
UScitizens

Mostoftheuninsured(46%)areWhite, nonHispanic
Black/AfricanAmericanmakeup24% andHispanic20%ofuninsured
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ClosingtheVirginiaCoverageGap: Whowouldbeeligible?
120% 100% FPL% 80% 60% 40% 20% 0% Pregnant Women Children05 Children618 Elderly% Disabled Parents ChildlessAdults

Optional400,000+Virginians CurrentlyMedicaidEligible

TheACAgivesVirginiatheoptiontoreceivefederalfundingtocoveran estimated400,000eligibleindividualswithincomesunder133%FPL. Basedonhistoricalaverages,anestimated248,000additionalVirginians wouldenrollandreceivehealthcoverage.Statesthatexpandcoverage, mustexpandcoverageto133%FPL.

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2014FederalPovertyLevel(FPL)Guidelines
Annual Family Income

Family Size 1 2 3 4 5
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100% FPL $11,670 $15,730 $19,790 $23,850 $27,910

133% FPL $15,521 $20,920 $26,320 $31,720 $37,120

185% FPL $21,589 $29,100 $36,611 $44,122 $51,663

200% FPL $23,340 $31,460 $39,580 $47,700 $55,820

Source: 2014 Federal Poverty Guidelines, U.S. Dept. of Health and Human Services 6

HowwouldVirginiapaytocoverour uninsured?
Cost Breakdown Year 2014 - 2016 2017 2018 2019 2020 - Future Virginia 0% 5% 6% 7% Up to 10% Federal 100% 95% 94% 93% At least 90%

TocovertheuninsuredinVirginia,thefederalgovernmentwouldpay100%of thecostforthenewlyeligibleMedicaidenrolleesuntilJanuary2017,when Virginiawouldbeginassumingaportionofthecosts.

ClosingtheCoverageGapandtheACA
HowistheAffordableCareActfunded? Howisthisfundingalready affectingVirginia? IsitoptionalforVirginiato participateinfundingthe AffordableCareAct? NO.Wearealready payingforitwithout receivingthebenefits!
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TheAffordableCareActFundsItself
ThenonpartisanCongressionalBudgetOfficerecently confirmedyetagainthatfederalhealthcarereformon balancefundsitself. Fundingsources:
1. Spendingreductionsonpublichealthprograms 2. Taxrevenues
Spending Reductions

ACA
NewTax Revenues

FundingforState Programs
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FundingSource#1: ReductionstoMedicarePayments
Thelargestspendingreductionisinpaymentstohospitals forMedicarepatients($196Bfrom20102019).

WhatdoesthismeanforVirginia?

FinancialhittoVirginiashospitals:
lossofover$1.5Billionfrom20142018

JoblossforVirginiacitizens:
Nearly1,000jobshavealreadybeenlostoraffectedin Virginia.
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FundingSource#2: IncreaseinFederalTaxes
ThelargestrevenuesourcefortheACAis$200Billion thatcomesfromunavoidabletaxincreases. Federalpayrolltaxincreaseof0.9%andinvestment incometaxincreaseof3.8%forhighincomeindividuals andfamilies($200,000&$250,000,respectively) WhatdoesthismeanforVirginia? Eachyear,regardlessofwhetherornotwecoverthe uninsured,Virginianswillpayout$2Billionintaxesand feestosupporttheACA.
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OutflowofVirginiaDollars
Thismoney couldbeused rightherein Virginiato coverour uninsured.

$5 Million EveryDay

$2Billion Every Year

$10 Billion est.over 5years

NOTE:ThetaxanalysisisbasedondatafromtheJuly24,2012CBOletterreporttoSpeakeroftheHouse JohnBoehner.
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FailingtoClosetheCoverageGap
Ifwedonotclosethecoveragegap,effectively reinvesting thismoneybackinVirginia,ourfamilies andbusinesseswillsendhardearnedtaxdollarsto Washingtonwithoutthebenefits,jobs,orrevenue returnedtoVirginia.
$2BilliontoFederalGovernment

$0BacktoVirginia

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SystemicEffectsofCoverage
Theeffectsofcoveringtheuninsuredcanbefeltbeyond economicsandindividualandpublichealth.

Mental Health Veterans Affairs

Covering the Uninsured

Education

Public Safety

Business
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SystemicEffectsofCoverage
MentalHealthAnestimated77,000adultsinVirginiahavementalillnesses andnoinsurancetopayfortreatmentormedication. PublicSafetyGainingaccesstotreatmentformentalhealthandsubstance abusemayeasetheburdenonVirginiaslawenforcementcommunity. Education Parentswhohavecoveragearemorelikelytogaincoveragefor theirchildren.Healthyparentsequalhealthystudents. Business Virginiasbusinessespayhigherpremiumsforemployeesto compensatefortheuninsured.Newbusinessesmaybelessinclinedto cometoVirginia,createjobs,andinfuseoureconomy. VeteransAffairsOfthemorethan30,000uninsuredveteransandtheir spouseswholiveinVirginia,nearly10,000uninsuredveteransandnearly 3,000oftheirspouseswillbeeligibleforcoverage.
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Whatareotherstatesdoing?

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Highlights
Whileanewprogramtocovertheuninsuredis optional,thenewtaxestocoverthecostsoffunding theACAarenot. Virginiawilllose$2Billionannuallywithoutcreating anewprogram. Medicaidisundergoingaseriesofreformsdesigned tocontrolcostsandstreamlinecare. CoveringtheuninsuredinVirginiawillnotonly providehealthcoveragetoindividualsinthegap,itwill havepositiveimpactsinpublicsafety,commerce, 17 education,andmentalhealth.

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Medicaidinthe th 44 District
Mt.Vernon&LeeCommunity

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CurrentMedicaidPopulation
12,532 Medicaid/FAMISPopulation
16%of44th DistrictResidents

Whoisthatpopulation?
748Adults 482Aged 432Other 633PregnantMothers 9,371Children

1in3Childreninthe44th District
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CostofCurrent44th District Population

OverallCost $42,738,651
$6,634,997AcuteCare $19,693,493 MCOPayments(ManagedCare) $6,215,443 LongTermCarePayments $9,628,692 PrimaryCarePayments $540,001 Pharmacy $237,417 DentalPayments

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WhyisUninsuredCarein44th a Problem?

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WhyIsUninsuredin44th AProblem?

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FairfaxCountyEmergencyRoomLow AcuityVisitsByZip(Enlarged)

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MostUtilizedProviders
Hospitals INOVAFairfax TheAlexandriaHospital INOVAAlexandria VAHospitalCenter Mt.VernonHospital NursingFacilities ManorCareof Alexandria,VirginiaLLC Mt.VernonNursing Center WoodbineRehabilitation HealthCenterLLC Leewood HealthCenter ManassasHealth& RehabilitationCenter
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WhatDoesClosingtheGapMeanfor the44th District?

UsingtheMedicaidChildPopulationasa Proxy
44th Districthas1.33%ofallMedicaidchildrenin VA

$24,349,859NewSpending 400NewJobs 5,337NewPeopleProvidedHealthInsurance

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VirginiaGeneralFundSavings
MedicaidExpansionFreesup$280MillionThisBiennium
DepartmentofCorrections IndigentCareatStateTeachingHospitals CommunityServicesBoards FreeClinics PregnantWomen BreastCancer FamilyPlanning

Howcouldthesesavingsbereappropriated?
LawEnforcement HigherEducation SecondaryEducation:

$27,636,012forFairfaxCounty $154.61perstudent 502NewTeachersat($55K/position)

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BOTTOMLINES
ExpansionWouldSaveVATaxpayersHundredsofMillions WouldFreeUpGeneralFundMoneyforOtherPurposes WouldProvideLastUninsuredwithDignityofHealthInsurance WillCreate30,000VirginiaJobs WillBringVAFederalTaxDollarsBacktoVirginiaandStopVA SubsidizingOtherStates WillControlExplodingPrivateMedicalInsuranceCosts IsSupportedby:
HealthCareIndustry VirginiaChamberofCommerce FairfaxCountyChamberofCommerce SenateofVirginia GovernorTerryMcAuliffe

IsOpposedby:
VirginiaHouseRepublicanCaucus
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